Provider Demographics
NPI:1639775604
Name:LAWLER, COURNEY (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:COURNEY
Middle Name:
Last Name:LAWLER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RIVERFRONT BLVD APT 322
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-3609
Mailing Address - Country:US
Mailing Address - Phone:609-335-9530
Mailing Address - Fax:
Practice Address - Street 1:160 PARMELEE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2925
Practice Address - Country:US
Practice Address - Phone:973-423-6415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002529002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer